Skip to main content
SpringerLink
Log in

The value of prophylactic chest tubes in tracheoesophageal fistula repair

  • Original Article
  • Published:
Pediatric Surgery International Aims and scope Submit manuscript

Abstract

Purpose

Intraoperative chest tubes (IOCTs) can be placed during esophageal atresia/tracheoesophageal fistula (EA/TEF) repair to control pneumothoraces and detect esophageal leaks, potentially preventing the need for postoperative chest tubes (POCTs). However, data are lacking regarding IOCTs’ effect. We hypothesized that IOCT placement would not reduce the risk of POCT placement and would increase hospital length of stay (LOS).

Methods

This was a single-center case-control study of type C EA/TEF patients repaired at a tertiary referral center between 2006 and 2017. Postoperative complications of patients who received IOCTs (n = 83) were compared to that of patients who did not receive IOCTs (n = 26). Patients were compared via propensity score matching. Additionally, sensitivity analyses excluding low birth weight (LBW) patients and patients undergoing delayed esophageal anastomosis were also performed.

Results

There was no significant difference in rates of pneumothoraces or esophageal leaks between the IOCT and no-IOCT groups, nor were either of these complications detected earlier in the IOCT group. Rates of POCT placement and mortality also did not differ between groups. IOCT patients were associated with increased hospital LOS (28 vs 15.5 days, p < 0.001) and esophageal strictures (30% vs 8%, p = 0.04) requiring a return to the operating room (RTOR).

Conclusion

IOCTs did not improve outcomes in EA/TEF repair. IOCTs seem associated with increased LOS and ROTR for esophageal stricture, suggesting that IOCTs may not be beneficial after EA/TEF repair.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Wang B, Tashiro J, Allan BJ, Sola JE, Pariph PP, Hogan AR, Neville HL, Perez EA (2014) A nationwide analysis of clinical outcomes among newborns with esophageal atresia and tracheoesophageal fistulas in the United States. J Surg Res 190(2):604–612. https://doi.org/10.1016/j.jss.2014.04.033

    Article  PubMed  Google Scholar 

  2. Lal D, Miyano G, Juang D, Sharp NE, St Peter SD (2013) Current patterns of practice and technique in the repair of esophageal atresia and tracheoesophageal fistula: an IPEG survey. J Laproendosc Adv Surg Tech A 23(7):635–638. https://doi.org/10.1089/lap.2013.0210

    Article  Google Scholar 

  3. Shawyer AC, Pemberton J, Flageole HH (2014) Post-operative management of esophageal atresia-tracheoesophageal fistula and gastroesophageal reflux: a Canadian Association of Pediatric Surgeons annual meeting survey. J Pediatr Surg 49(5):716–719. https://doi.org/10.1016/j.jpedsurg.2014.02.052

    Article  PubMed  Google Scholar 

  4. McCallion WA, Hannon RJ, Boston VE (1992) Prophylactic extrapleural chest drainage following repair of esophageal atresia: is it necessary? J Pediatr Surg 27(5):561

    Article  CAS  Google Scholar 

  5. Fowler CL (1995) Subclavian artery compression from a chest tube after thoracotomy in a premature infant. Pediatr Radiol 25(6):458–459

    Article  CAS  Google Scholar 

  6. Johnson JF, Wright DR (1990) Chest tube perforation of esophagus following repair of esophageal atresia. J Pediatr Surg 25(12):1227–1230

    Article  CAS  Google Scholar 

  7. Aslanabadi S, Jamshidi M, Tubbs RS, Shoja MM (2009) The role of prophylactic chest drainage in the operative management of esophageal atresia with tracheoesophageal fistula. Pediatr Surg Int 25(4):365–368. https://doi.org/10.1007/s00383-009-2345-7

    Article  PubMed  Google Scholar 

  8. Gawad N, Wayne C, Bass J, Nasr A (2018) A chest tube may not be needed after surgical repair of esophageal atresia and tracheoesophageal fistula. Pediatr Surg Int 34(9):967–970. https://doi.org/10.1007/s00383-018-4307-4

    Article  CAS  PubMed  Google Scholar 

  9. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde NG (2009) Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42(2):377–381. https://doi.org/10.1016/j.jbi.2008.08.010

    Article  PubMed  Google Scholar 

  10. Gu X, Rosenbaum PR (1993) Comparison of multivariate matching methods: structures, distances and algorithms. J Comput Graph Stat 2:405–420

    Google Scholar 

  11. R Core Team (2018). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. URL https://www.R-project.org/.

  12. Kay SM, Shaw K (1999) Revisiting the role of routine retropleural drainage after repair of esophageal atresia with distal tracheoesophageal fistula. J Pediatr Surg 34(7):1082–1085. https://doi.org/10.1016/S0022-3468(99)90571-7

    Article  CAS  PubMed  Google Scholar 

  13. Paramalingam S, Burge DM, Stanton MP (2013) Operative intercostal chest drain is not required following extrapleural or transpleural esophageal atresia repair. Eur J Pediatr Surg 23(4):273–275. https://doi.org/10.1055/s-0032-1330845

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Pediatric Surgery, The Saban Research Institute, Children’s Hospital Los Angeles, 4650 Sunset Blvd., Mailstop #100, Los Angeles, CA, 90027, USA

    Michelle V. L. Nguyen, Patrick T. Delaplain, Joanna C. Lim, Jamie M. Golden & Christopher P. Gayer

Authors
  1. Michelle V. L. Nguyen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Patrick T. Delaplain
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Joanna C. Lim
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jamie M. Golden
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Christopher P. Gayer
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conceptualization and methodology: Christopher P. Gayer; Methodology: Joanna C. Lim, Jamie M. Golden, Patrick T. Delaplain, Michelle V.L. Nguyen; Formal analysis and investigation: Patrick T. Delaplain, Michelle V.L. Nguyen; Writing-original draft preparation: Michelle V.L. Nguyen; Writing-review and editing: Michelle V.L. Nguyen, Christopher P. Gayer, Patrick T. Delaplain; Supervision: Christopher P. Gayer.

Corresponding author

Correspondence to Christopher P. Gayer.

Ethics declarations

Conflict of interest

The authors have no disclosures or conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (include the name of committee + reference number) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 20 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nguyen, M.V.L., Delaplain, P.T., Lim, J.C. et al. The value of prophylactic chest tubes in tracheoesophageal fistula repair. Pediatr Surg Int 36, 687–696 (2020). https://doi.org/10.1007/s00383-020-04664-6

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00383-020-04664-6

Keywords

Search

Navigation